Education and Human Patient Simulation

One of Joel Kaplan's legacies to the Department was his insistence upon creating a mandatory clerkship for third year medical students. The effects were immediately apparent, as many Mount Sinai students have since chosen careers in anesthesiology. Currently, with Michael Chietero as the Department Director of Medical School Education, the Department offers instruction throughout the four years of the curriculum. In the students' first year, the human patient simulator has become an integral part of the physiology course. It is used for a hands-on practical review of pulmonary and cardio-vascular physiology. The third year one week required clerkship apprentices each student to one or two attending preceptors and is divided between the OR's, didactic sessions, and patient simulator sessions. In the OR, hands-on experience in airway management and intravenous cannulation is emphasized. Throughout the four year student experience, numerous elective courses are available and are eagerly subscribed to by the student body.

Under the direction of Adam Levine, the Anesthesiology Residency Training Program just obtained its fifth consecutive 5-year accreditation from the Accreditation Council for Graduate Medical Education, accompanied by approval for permanent expansion of the program to educate a total of 96 total residents through a four-year continuum. In July, 2010, the program began to offer an integrated PGY-1 year. During the PGY-2, 3, and 4 years, residents receive a three-year program of progressive responsibility. The clinical, basic science, and educational research advances are described below.

The history of simulation at Mount Sinai is a story unto itself and needs to be emphasized. In the words of Adam Levine, the Director of the Simulator Center:

In 1994, the Department of Anesthesiology made history by being the first beta test site for the first full scale mannequin simulator that was manufactured by Loral Defense Corporation (now Lockheed Martin). The Human Patient Simulator was based on a simulation platform (Gainesville Anesthesia Simulator) that would ultimately be manufactured by Medical Education Technologies Incorporated (METI), the world's leading model-driven simulator manufacturer. In 1997, the Department made history again when the second simulator arrived, making Mount Sinai the first multi-simulator center in the world. Using non-operational OR's at Mount Sinai, the Department's simulation program continued to grow. In 2002, the Department inaugurated the HELPS (Human Emulation, Education, Evaluation, Lab for Patient Safety and Professional Study) Center that houses three adult simulators (one of which is mobile), and a child and an infant simulator in two virtual operating room environments. In addition, the center has several part-task trainers for virtual bronchoscopy, colonoscopy and transesophageal echocardiography (TEE). The HELPS Center occupies approximately 2000 square feet and incorporates teleconferencing capability.

Over the past 17 years, the simulation team has developed and conducted innovative simulation-based education and assessment programs. The HELPS Center program conducts multidisciplinary educational activities for Mount Sinai medical students including our extensive curriculum of basic science physiology laboratories and for postgraduate trainees from a variety of medical disciplines, including anesthesiology, internal medicine, pediatrics, emergency medicine, critical care, and otolaryngology. The team has developed and conducted courses for critical care nurse practitioners, graduate students, and has been host to a variety of community based services for local elementary, middle and high school students.

The Center offers a unique simulator elective for medical where they learn to program, operate, and educate with human simulators. The students develop their own curricula and help teach during existing simulator-based sessions. The Center serves as the core facility for the Clinical Educator Track, which is a select group of anesthesiology residents interested in academic careers; the residents are mentored to create simulator-based educational programs for medical students, residents, and retraining physicians. These residents organize and conduct large portions of the medical student education program.

In addition to education, the program has developed novel simulator-based clinical competency assessments, remediation evaluations, and retraining programs for licensed physicians and those wishing to reestablish licensure. The team has written chapters and articles on the use of simulation for competency assessment, recertification, and retraining.

The Departmental simulation program gained American Society of Anesthesiologists (ASA) accreditation as an official ASA endorsed Simulation Program in 2009. With the endorsement, the Department conducts simulation-based educational activities to satisfy one of the American Board of Anesthesiologists (ABA) Maintenance of Certification for Anesthesiologists (MOCA) requirements.

Starting in 1983, George Silvay founded the Annual Symposium: Clinical Update in Anesthesiology, Surgery and Perioperative Medicine series of educational meetings. Currently, with Marc Stone as Co-Director, the 29th Annual Symposium was recently held. This week long meeting includes internationally renowned faculty and attracts hundreds of international participants from around the world. Dr. Silvay has also arranged numerous continuing education meetings in Europe.

An extraordinary educational resource is housed in the Departmental Intranet that is maintained by David Wax. Included are policies, procedures, links to organizations and agencies, knowledge bases, communication tools, and full text articles covering the gamut of anesthesia management. Dr. Wax has lectured nationally on the creation of this type of resource.